The complaint was filed by a local urologist who said he's seen a number of cases of priapism in patients of a Minnesota clinic who end up in the ER. (Shutterstock)

A complaint has been filed against the Minneapolis Men’s Clinic in Bloomington, Minnesota, on behalf of one of several patients who says the clinic pushed him into buying injectable erectile dysfunction drugs that caused a painful episode of priapism.

The complaint was filed with the Minnesota Attorney General’s Office and the state Board of Medicine by Karl Kemberling, a local urologist who ended up treating the patient for an erection that lasted more than eight hours. (He was unable to reach anyone at the clinic after-hours.) Kemberling says he and his partners have seen a number of cases of priapism in patients of the clinic who end up in the emergency room. He told the Star Tribune, “We … consider their lack of care medical negligence or patient abandonment.”

According to reports, the clinic appears to be pushing injectable treatments over the more widely used oral medications, which are less likely to cause this condition.

Erectile dysfunction (ED) is defined as the inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. In order to be diagnosed with ED, the issue must affect a man’s physical and psychosocial health and have significant impact on his quality of life and that of his partners or family. It is estimated that 20 to 30 percent of men suffer from ED at some point, with 5 to 20 percent of men reporting moderate to severe cases. The likelihood of ED increases as men age.

ED can have its roots in physical and/or psychological issues. Erections require increased blood flow to the penis, which means that cardiovascular problems such as heart disease, clogged blood vessels, high blood pressure, high cholesterol, diabetes, obesity, and heavy smoking can contribute to trouble getting or maintaining an erection. Other health issues such as Parkinson’s disease and multiple sclerosis can also increase the likelihood. Some prescription medications are known to limit sexual desire and functioning, as can some illicit drugs and even alcohol when used in excess. Other issues more closely associated with sexual function also increase the risk of ED, such as prostate cancer and treatments for prostate cancer, low testosterone levels, and injuries to or surgeries on the pelvic area or spinal cord. Relationship issues and other psychological issues such as depression and anxiety can also affect erectile functioning.

Although the ideal treatment for most men would address both the physical and psychological realms, since the introduction of Viagra in 1988 most doctors and patients turn first to PDE5 inhibitors. By blocking the PDE5 enzyme, the medications help the smooth muscles in the penis relax and increase blood flow to the penis. Other PDE5 inhibitors have been introduced since then, including Tadalfil (sold as Cialis) and Vardenfil (sold as Levitra). The differences between these drugs are mainly in how long they take before they begin to work and how long they last in the body before they stop working.

As with any medication, there are side effects to PDE5 inhibitors. Common side effects include headaches, flushing, indigestion, nasal congestion, and dizziness. About 2 percent of patients experience vision issues that include seeing a blue haze, temporary increased brightness, and even sudden vision loss or partial vision loss. Though all advertisements for these drugs warn of the multi-hour erection, cases of priapism are very rare.

Before 1988, doctors often relied on drugs that were injected into the penis with a fine-gauge needle. The most common of the drugs is alprostadil, which is marketed under the names Caverject Impulse or Edex. Other drugs include papaverine and phentolamine. These can be used in combination and the dose can be tinkered with for each patient. Side effects can include bleeding from the injection, formation of fibrous tissue at the injection site, and prolonged erections. These drugs are still available but are no longer considered first-line treatments.

Yet patients at the Minneapolis Men’s Clinic say they were given the hard sell on this type of treatment, and the long erection appears to be a part of the sales tactic. The clinic’s website says its treatment is unique:

Our pharmacy custom blends your prescription medication so that after you achieve a climax your penis will stay erect for the entire requested amount of time whether it’s 45 minutes, 90 minutes, and hour or more. This allows you to achieve a second climax (the sensation is greater each time) and adequately please your partner.

One man, a 63-year-old retired surgeon, who spoke to the Star Tribune on the condition of anonymity, said that he went to the clinic in response to an ad offering a free trial of ED treatment. After he met with a clinic doctor, he was handed over to a salesman for the treatment who was pushing a one-year supply, for a total cost of $2,800. When he asked if he could start with a smaller supply, the salesman “rolled his eyes” and “acted like that would be difficult.” The first time the man gave himself an injection he ended up with an erection that would not go down. He tried cold baths and Sudafed (a decongestant that contracts blood vessels, which was given to him by the clinic for just this situation), but neither worked. He ended up in the emergency room, after he wasn’t able to get in touch with anyone at the clinic, where doctors inserted a large needle into his penis to extract the blood. He called the treatment excruciating. The retired doctor tried the self-injected ED drugs one more time in a lower dose and wound up in the ER yet again. As he told the Star Tribune, “The stuff worked, it just didn’t unwork.”

According to the Star Tribune, Thomas Lund, a regional medical director at the Bloomington clinic, said the clinic does have a 24-hour emergency hotline with medical staff. “These claims by the local urology clinic are baseless and motivated by an attempt to drive out their competition,” Lund told the newspaper in an email.

The Men’s Clinic is one of a chain of 14 clinics across the country, which was founded by Dr. Kevin Hornsby, who self-published a book on ED and says his clinics offer an alternative to Viagra and other pills. According to the Star Tribune, the Better Business Bureau has received 19 complaints against Men’s Clinics in various states.

Why don’t these doctors have to have admitting privileges? Were their patients required to wait 72 hours so they can make a more educated and informed choice? Humpfff, I guess they should keep their wanks in their pants if they don’t want to deal with the consequences.

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I think they should have to wait 72 hours each time it occurs to them that they want to have sex. And they need a note from their mother and an ultrasound. Then they need to listen to the heartbeat of every one of the approximately 300 billion sperm they are going to condemn to an agonizing death of dehydration. Let’s care for men’s health the way they so kindly want to care for womens’!